[Pharmaceutical applications of sulfobuthylether-beta-cyclodextrin].

Sulfobuthylether-beta-cyclodextrin (SBECD) is a substituted derivative of a cyclic oligosaccharide containing seven glucopyranose units, which bear pH-independent negative charges because of sulfonate groups. This derivative has better solubility and toxicological characteristics than the unsubstituted beta-cyclodextrin, and the presence of sulfobuthyl groups opens new dimensions in the interactions acting the part of the complex formation. These create opportunities for the pharmaceutical applications of this compound.

Long-term follow-up of DDH patients who underwent open reduction without a postoperative cast.

We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.

Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery.

Background: Congenital thrombophilia is responsible for thromboembolic complications despite prolonged low-molecular-weight heparin (LMWH) prophylaxis following hip and knee endoprosthesis surgery.

Methods: A series of 86 patients with hip or knee endoprosthesis surgery were assessed 1 year after operation. Antithrombin III, protein C, and protein S were determined, and the activated protein C sensitivity ratio was measured.

Increased platelet activation and decreased fibrinolysis in the pathogenesis of aseptic necrosis of the femoral head.

Thrombotic events, increased tendency toward intravascular thrombosis and decreased fibrinolysis seem to be possible pathologic causes for aseptic necrosis of the femoral head (ANFH) in adults. This project was to study whether either increased platelet activation or decreased fibrinolytic activity and/or any other thrombogenic factor may be implicated in the evolvement of ANFH. The speed of the in vitro lysis was significantly lower in patients (both in primary and in secondary cases) compared with healthy controls.

The most severe forms of Perthes' disease associated with the homozygous Factor V Leiden mutation.

It has recently been postulated that thrombophilia may have a role in the aetiology of Perthes' disease. The published reports, however, remain conflicting. In this study a retrospective analysis of the coagulation parameters was made in 47 patients with Perthes' disease and the results compared with the clinical data.

Histological changes in the symptomatic mediopatellar plica.

One of the causes of anterior knee pain may be symptomatic mediopatellar plica. The pain is usually attributed to the mechanical damage caused by the plica inside the joint, or, more precisely, to the synovitis induced as a result. Recent observations seem to suggest, however, that the pain is, in addition, likely to be engendered by an increased number of nerve-elements present in the substance of the plica.

Capsular neuronal elements and their relation to pain reduction and functional improvement following total hip replacement.

We studied changes of pain intensity and functional impairment in 22 patients with osteoarthrosis undergoing total hip replacement. Using a visual analogue scale, the mean scores for pain and disability before surgery were 71.7 and 70.

Thrombotic and fibrinolytic alterations in the aseptic necrosis of femoral head.

Recent reports seem to support the role of the thrombophilia and decreased fibrinolysis in the aetiopathogenesis of aseptic necrosis of bone. In the present study, haemostatic disturbances were analysed in adults (n = 49) and patients in childhood (Perthes disease) (n = 47) with aseptic necrosis of the femoral head. Fibrinolytic parameters (in vitro clot lysis, plasminogen, plasmatic plasminogen activator inhibitor-1 activity, D-dimer) along with lipoprotein (a) [Lp(a)] and fibrinogen were measured.

Multilevel callus distraction: a novel idea to shorten the lengthening time.

Lower extremity inequality is a common problem in everyday orthopaedic practice. The leg discrepancy can lead to variety of other problems, i.e.

Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope.

We demonstrate the technique, advantages, and disadvantages of metacarpophalangeal joint examination with needle arthroscope. We evaluated our experience from biopsies of 10 metacarpophalangeal joints of eight rheumatoid women aged 41-45 years. The procedures were performed using a 1-mm needle arthroscope.

Contradictions of derotation in scoliosis surgery using the CD principle.

Current literature has increasingly emphasized the problem of derotation in scoliotic deformities. The Cotrel-Dubousset (CD) principle as a means of correcting rotation has been questioned by various authors. This paper aims to draw attention, using algebraic methods, to the importance of the remaining rotational deformities, and to suggest the introduction of the notion 'rotational balance'.

The 'rotational preconstraint'.

This model provides a novel view of the etiology of some scolioses and can answer some of the biomechanical questions regarding pathogenesis of dorsal curves. According to our findings, paravertebral muscular imbalance is likely to favour such a pathological condition which, with the interference of the postural reflexes and the body weight-related vertical loading, might lead to the formation of a true scoliotic curve. Review of earlier research studies in the light of our findings reveals controversy in some authors' reported results and their own interpretations and seems to generally support our theory.

Functional improvement after knee arthroplasty without resurfacing of patella.

There has been no universal agreement so far regarding the necessity of patellar resurfacing in total knee arthroplasty. As resurfacing has been reported to be associated with high incidence of complications, this practice has been avoided in our Department. A report is given on the analysis of the functional outcome of 60 knee arthroplasties without patellar resurfacing in 53 patients (7 bilateral) followed up for twelve to thirty months, with special regard to the functions closely related to patelloformal articulation.

The importance of arthroscopy in diagnosing synovial haemangioma of the knee joint.

In connection with one of their cases, authors call attention to the importance of differential diagnosis in synovial haemangioma of the knee joint, a rare condition. They also give a survey of its clinical, radiological and pathological features, review the literature on the topic, with special emphasis on the importance of arthroscopy in making the clinical diagnosis, and describe the treatment applied in their case.

Efficacy of prevention of thromboembolic complications with LMW-heparin in experiment.

The authors used an antithrombotic agent (Nadroparin Calcium) with anti-Xa effect in their experiments to prevent thromboembolic complications in the model of endoprosthetic replacement of the hip joint in mongrel dogs. 10 experimental animals (Group I.) were given doses of 100 A Xa ICU/kg/bwt of Nadroparin Calcium subcutaneously 4 hours prior to the operation and also once a day until the 3rd postoperative day; between the 4th and 10th postoperative days doses of 150 A Xa ICU/kg/bwt Nadroparin Calcium were given.

Idiopathic scoliosis--new surgical methods or search for the reasons.

Idiopathic scoliosis (IS) is a deformity of the spine whose aetiology is unknown despite of extensive clinical and basic research work. The significance of this disease lies in the consequences of a spine deformity (deformation of the chest, compromise of the cardio-pulmonar function, compression of the neurological elements, severe somatic and psychological sufferings). According to statistical data, one third of the idiopathic scoliotic cases progress and need surgical intervention.

Therapeutic value of continuous passive motion after anterior cruciate replacement.

The aim of this study is the evaluation of the therapeutic value of continuous passive motion after ACL replacement. After 41 ACL reconstruction in 13 cases only active motion, in 28 cases active motion and CPM were used postoperatively. Stability, the range of motion and complications were evaluated at the time of discharge, 3 and 6 months after the operation.

Experimental studies for the surgical correction and fixation of dorsal spine deformities.

One of the specific features of the scoliosis operations with a posterior approach is that both the correction of the deformity and then the maintaining of the corrected situation are carried out with the help of the implants. With the currently applied systems based on the CD principle it is still difficult to control the rotational component of the scoliotic curve. To complement the systems based on the CD principle, we have developed an implant family whose application makes the correction of the dorsal deformity generally simplier and derotation more effective.

Pemberton's pericapsular osteotomy for the treatment of acetabular dysplasia.

We present the results of 80 Pemberton procedures carried out between 1977 and 1990. The patient age at the time of operation ranged between 2 and 12 years, and follow-up was between 1 and 15 years. Before Pemberton's operation, conservative treatment, closed and open reduction, and derotation femoral osteotomy were used.

Preliminary results of early open reduction by an anterior approach for congenital dislocation of the hip.

We report the results of 113 early open reductions of congenitally dislocated hips using a technique we have developed. Surgery is followed by functional postoperative treatment with a Pavlik harness or abduction splint. The age of the patients and the follow-up period ranged from 6 to 24 months and 2 to 12 years, respectively.

[Indication for Chiari's pelvic osteotomy].

The results of 61 Chiari's pelvic osteotomies carried out during a 10 years period are reported. Present role of the operation in the correction of acetabular dysplasia in comparison to Pemberton's acetabuloplasty, to triple pelvic osteotomies and to the prosthetic replacement of the hip joint is discussed. In conclusion the operation is still indicated in special cases.

[Results of early surgical reduction of congenital hip dislocation].

Authors report on the results of 118 early operative reductions, performed with their own method in the treatment of the congenital dislocation of the hip. Postoperative functional treatment with Pavlik's harness or abduction splint belongs to their method. Secondary operations were performed in 21 per cent: derotation femoral osteotomy and Pemberton's operation.